Because of the invasive nature of traditional surgery there are inherent risk and objectionable side effects associated therewith. For example if a patient is found to have an inflammatory stricture in the small intestine and it is decided to surgically remove the section of the intestine containing the stricture and reconnect the severed ends of the intestine by sutures. Such invasive surgery requires a general anesthesia, is time consuming, expensive and is painful and requires a long healing process. As a result less invasive procedures are being developed as alternatives to traditional surgical procedures.
Draining viscera, such as the stomach or gall bladder, can be performed through a track inserted percutaneous into the viscera, however, there is the danger that gastric juices, bile or infected fluids could spill into the peritoneal cavity. To prevent this, procedures and devices have been developed to pull and anchor the wall of the viscera into contact with the abdominal wall using sutures anchor devices that are inserted into the cavity of the viscera through thin hollow needles. With the viscera thus stabilized with its wall held flush against the abdominal wall, drain tubes can be inserted into the viscera without the danger of spillage into the peritoneal cavity. Examples of viscera anchor of this type are shown in U.S. Pat. Nos. 5,123,914 and 6,110,183. The anchors disclosed in U.S. Pat. Nos. 5,123,914 and 6,110,183 are constructed to prevent damage to the interior of the viscus and can be inserted and removed through small diameter needles.
Another method and device, now in use, that avoid the trauma of traditional surgery, is a method and apparatus for creating abdominal visceral anastomoses. This method and device, is disclosed in U.S. Pat. No. 5,690,656, uses a pair of powerful magnets, each having a raised rim around their perimeter. The patient swallows one magnet, then waits until it has worked its way into the jejunum, then the patient swallows the second magnet which works its way into the stomach. The location of the magnets can be monitored and manipulated such that they become attracted to each through the walls of the stomach and the jejunum. The magnets apply pressure to the tissue that is held between the raised rims. After a few days, the tissue between the magnets becomes necrotic and the two magnets together pass into the jejunum and eventually pass through the bowel. A stent can then be endoscopically placed in the resulting opening, to prevent the opening from closing. The procedure disclosed in U.S. Pat. No. 5,690,656, although less invasive than traditional surgery, extends over a several day period and the precise placement of the magnets is problematic. Thus, a one-step procedure and apparatus for anastomosing two hollow viscera by a percutaneous technique in which the surgeon has greater control over the location of the anastomosis is needed.
The present invention relates to a method and the apparatus for anastomosing two hollow viscera using a technique that is an improvement over the method and apparatus discussed above. This technique can be performed percutaneously but could also be performed through the patients mouth. The suture anchor is modified by adding a T-bar to the suture that can be caused to slide along the suture to a position proximal to the stationary suture anchor that is located at the distal end of the suture. A hollow needle containing this improved anchor assembly devise pierces the patient""s abdominal wall, extends into the stomach and then through the stomach into the jejunum. The stationary anchor, carried at the distal end of the suture, is then released into the jejunum and the needle is withdrawn back into the stomach where the sliding anchor is released from the needle. The needle is then withdrawn leaving the suture extending from the anchors out through the needle hole in the abdominal wall. The needle is then replaced, over the suture, by a small dilator/pusher. The pusher is then used to push or slide the sliding anchor distally until the tissue between the stationary and sliding anchors are in close contact. After the anchor has been placed, the suture can be severed at the sliding anchor. Depending upon the size and location of the viscera between which the anastomosis is to be formed, the number of anchors that will be placed may be one or multiple. In the example disclosed herein, several anchors were placed to create an area of tissue contact between the outer surfaces of the viscera. This area of tissue contact is then penetrated by another needle and a wire guide is placed through this newly created aperture, over which a sheath dilator combination is placed. The size of the puncture formed in the area of tissue contact is enlarged and a stent is placed through the puncture. The stent can be a Z-type stent which is a self-expanding stent formed of stainless steel wire that is arranged in a closed zigzag pattern. The Z-stent is compressed into a reduced size shape so that it can be placed in passageway in a patient by means of a sheath. Reference may be made to U.S. Pat. No. 4,580,568 for a completed disclosure of a Z-stent.
This technique for anastomosing two hollow viscera has advantages over the method disclosed in U.S. Pat. No. 5,690,656 since it is much faster, it being completed in one visit as opposed to at least two visits that are days apart. Also, this method allows the surgeon more control over the exact location of the anastomosis.